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Safety and Efficacy of Intravenous ACZ885 and Oral Methotrexate Therapy in Patients With Early Rheumatoid Arthritis

Primary Purpose

Rheumatoid Arthritis

Status
Completed
Phase
Phase 2
Locations
International
Study Type
Interventional
Intervention
Canakinumab (investigational)
Placebo
Methotrexate (MTX)
Sponsored by
Novartis
About
Eligibility
Locations
Arms
Outcomes
Full info

About this trial

This is an interventional treatment trial for Rheumatoid Arthritis focused on measuring ACR20, ACR50, ACZ885 (anti-interleukin-1beta monoclonal antibody), rheumatoid arthritis, methotrexate

Eligibility Criteria

18 Years - 75 Years (Adult, Older Adult)All SexesDoes not accept healthy volunteers

Inclusion Criteria:

  • Male and female patients of 18 to 75 years of age (inclusive)
  • Recent definite diagnosis of rheumatoid arthritis (RA) (<3 years since diagnosis), classified by American Rheumatism Association 1987 revised criteria.
  • Candidate for methotrexate (MTX) or biologic due to erosive arthritis, with no contraindications to such therapy, including:
  • Negative tuberculin skin test reaction
  • Normal chest X-ray (within the last year) prior to possibility of receiving MTX (r/o lung fibrosis).
  • Active disease: at least 6 swollen and 6 painful tender joints of 28 joint count,
  • Vital signs should be within the following ranges:
  • 18-59 years of age: oral temperature between 35.0-37.5 °C systolic blood pressure, 90-140 mm Hg diastolic blood pressure, 50-90 mm Hg pulse rate, 40 - 90 beats per minute
  • 60-75 years of age: oral temperature between 35.0-37.5 °C systolic blood pressure, 100-160 mm Hg diastolic blood pressure, 50-100 mm Hg pulse rate, 50 - 100 beats per minute
  • Women of child-bearing potential willing to practice double-barrier contraception during the study for at least 3 months following last study drug administration. Postmenopausal women must have no regular menstrual bleeding for at least 1 year prior to inclusion. Surgically sterilized women at least 6 months prior to screening.

Male patients must be using a double-barrier local contraception and refrain from fathering a child in the 3 months following last study drug administration.

  • Weight: at least 45 kg; body mass index (BMI) within the range of 18 to 34.
  • Oral corticosteroids are permitted as long as patients are on a stable dose (up to 10 mg) for at least 4 weeks before study start.

Exclusion Criteria:

  • Unable to have Magnetic Resonance Imaging (MRI) of wrist.
  • Patients with magnetizable metal parts/devices on and in the body that could interfere with the MRI
  • Patients with an unstable active medical condition that could impair evaluation of study results.
  • Previous treatment with biological therapy or MTX.
  • Limited kidney function (creatinine clearance under 60 ml/min)
  • Previous treatment with other disease-modifying anti-rheumatic drugs such as sulfasalazine, hydroxychloroquine within 4 weeks of screening.
  • Corticosteroids injections into joints within 4 weeks prior to screening.
  • Participation in any clinical investigation within 4 weeks prior to study start or longer if required by local regulations, and for any other limitation of participation based on local regulations.
  • Blood donation or loss of > 400 mL within 8 weeks before study start, or longer if required by local regulation.
  • Significant illness within 2 weeks of study start.
  • Past personal or family medical history of clinically significant ECG abnormalities or cardiac issues.
  • History of:

    • fainting, orthostatic hypotension, sinus arrhythmia asthma and chronic obstructive pulmonary disease, clinically significant drug allergy or urticaria, eczematous dermatitis, and/or known hypersensitivity to the study drug or drugs similar to the study drug.
    • disease of the blood building system, serious or active infections, gastric ulcers.
    • surgical or medical condition which might significantly alter the absorption, distribution, metabolism or excretion of drugs or which may jeopardize the patient in case of participation in the study.
    • immunodeficiency diseases, including a positive Human Immunodeficiency Virus (HIV) (ELISA and Western blot) test result.
    • positive Hepatitis B surface antigen (HBsAg) or Hepatitis C test result.
    • drug or alcohol abuse within the 12 months prior to dosing or evidence of such abuse.

Sites / Locations

  • Rheumatology Associates of Northern Alabama (Dr. William Shergy)
  • Clinic for Rheumatic Diseases (Dr. Richard Jones, III)
  • Arizona Arthritis and Rheumatology Research (Dr. Paul Caldron)
  • Jacksonville Center for Clinical Research (Dr. Steven Mathews)
  • Center for Arthritis and Rheumatic Diseases (Dr. Michael Weitz)
  • West Broward Rheumatology Associates, Incorporated (Dr. Elias Halpert)
  • Rockford Orthopedic Associates (Dr. Richard Olson)
  • Mercy Arthritis and Osteoporosis Center (Dr. Alan Braun)
  • Clayton Medical Research (Dr. Iri Don)
  • Westroads Medical Group (Dr. William Palmer)
  • Arthritis Center of Reno (Dr. Malin Prupas)
  • Oklahoma Center for Arthritis therapy and Research (Dr. James McKay)
  • MetaClin Research, Incorporated (Dr. Paul Pickrell)
  • John M. Joseph, MD (Dr. John Joseph)
  • Southwest Rheumatology, P.A. (Dr. Atul Singhal)
  • Arthritis Clinic of Northern Virginia (Dr. Philip Kempf)
  • Arthritis Northwest Rheumatology, PLLC (Dr. Jeffrey Butler)
  • Novartis Investigative site
  • Novartis investigative site
  • Novartis investigative site
  • Novartis Investigative site
  • Novartis investigative site

Arms of the Study

Arm 1

Arm 2

Arm Type

Experimental

Active Comparator

Arm Label

Canakinumab + Methotrexate

Methotrexate + placebo

Arm Description

Canakinumab, human anti-interleukin-1beta monoclonal antibody plus Methotrexate (MTX). Intravenous (IV) Infusion of 600mg canakinumab on Day 1, 15 continuing every 4 weeks up to week 26. MTX was given as variable dosing regimen of 7.5 mg-15 mg weekly.

Methotrexate (MTX) was given as variable dosing regimen of 7.5 mg-15 mg weekly. Intravenous (IV) Placebo Solution, given in the same mode of administration as the canakinumab solution.

Outcomes

Primary Outcome Measures

Response to Intravenous Canakinumab and Oral Methotrexate (MTX) Compared to MTX Alone as Determined by 50% Improvement in Symptoms According to the American College of Rheumatology Criteria (ACR50)
A patient was considered as improved according to the ACR50 criteria if she/he had at least a 50 % improvement in both the tender and the swollen 28-joint count, and in at least 3 of the following 5 measures: Patient's pain assessment (Visual Analogue Scale (VAS) 100 mm) Patient's global assessment of disease activity (VAS 100 mm) Physician's global assessment of disease activity (VAS 100 mm) Patient self-assessed disability (Health Assessment Questionnaire (HAQ) score) Acute phase reactant (high sensitivity C-reactive Protein (hsCRP))

Secondary Outcome Measures

Response to Intravenous (IV) Canakinumab and Oral Methotrexate (MTX) Therapy (ACR20, 70, 90) Compared to MTX Alone
A patient was considered as improved according to the criteria of ACR 20 equaling at least 20%, ACR70 = 70%, and ACR90 = 90% improvement in the tender and the swollen 28-joint count, and in at least 3 of the following 5 measures: Patient's pain assessment (Visual Analogue Scale (VAS) 100 mm) Patient's global assessment of disease activity (VAS 100 mm) Physician's global assessment of disease activity (VAS 100 mm) Patient self-assessed disability (Health Assessment Questionnaire (HAQ) score) Acute phase reactant (high sensitivity C-reactive Protein (hsCRP))
Percentage of Participants Achieving a Good European League Against Rheumatism (EULAR) Response (Based on the Disease Activity Score (DAS28)) at 26 Weeks
At each visit (including baseline) the DAS28 is derived as: DAS28 = 0.56*√ (tender28) + 0.28 * √ (swollen28) + 0.36 * loge(CRP+1) + 0.014*PGDA+ 0.96; where tender28 is the tender 28-joint count, swollen28 is the swollen 28-joint count, PGDA is the patient's global assessment of disease activity. Patients can be scored on a range of 0 to 10. When current DAS < 3.2, good response is defined as >1.2 improvement in DAS from baseline and non-response is improvement of ≤0.6. When current DAS >5.1, non-response is improvement of >0.6 but ≤1.2 . All others are moderate responses.
The Number of Participants in Clinical Remission Based on Disease Activity Score (DAS)28 and Simplified Disease Activity Index (SDAI)
At each visit (including baseline) the DAS28 and SDAI variables were derived using the following formulas: DAS28 = 0.56*√ (tender28) + 0.28 * √ (swollen28) + 0.36 * loge(CRP+1) + 0.014*PGDA+ 0.96; SDAI = tender28 + swollen28 + CRP + (PGDA / 10) + (EGDA / 10) where tender28 is the tender 28-joint count, swollen28 is the swollen 28-joint count, CRP is C-reactive protein, PGDA is the patient's global assessment of disease activity and EGDA is the physician's global assessment of disease activity. The Number of Participants in clinical remission is defined as the DAS28 ≤ 2.6 or SDAI ≤ 3.3.

Full Information

First Posted
June 18, 2007
Last Updated
July 24, 2012
Sponsor
Novartis
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1. Study Identification

Unique Protocol Identification Number
NCT00487825
Brief Title
Safety and Efficacy of Intravenous ACZ885 and Oral Methotrexate Therapy in Patients With Early Rheumatoid Arthritis
Official Title
A 26-week, Phase II, Multi-center, Randomized, Double-blind, Placebo-controlled Study to Assess the Response to Treatment (ACR50) and to Determine a Biomarker Profile in Responders to ACZ885 (Anti-interleukin-1beta Monoclonal Antibody) Plus MTX as Compared to MTX Alone in Early Rheumatoid Arthritis Patients
Study Type
Interventional

2. Study Status

Record Verification Date
July 2012
Overall Recruitment Status
Completed
Study Start Date
March 2007 (undefined)
Primary Completion Date
December 2008 (Actual)
Study Completion Date
December 2008 (Actual)

3. Sponsor/Collaborators

Responsible Party, by Official Title
Sponsor
Name of the Sponsor
Novartis

4. Oversight

Data Monitoring Committee
No

5. Study Description

Brief Summary
This study was intended to evaluate the safety and efficacy of intravenous (IV) ACZ885 and oral methotrexate (MTX) therapy in patients with early rheumatoid arthritis (RA)

6. Conditions and Keywords

Primary Disease or Condition Being Studied in the Trial, or the Focus of the Study
Rheumatoid Arthritis
Keywords
ACR20, ACR50, ACZ885 (anti-interleukin-1beta monoclonal antibody), rheumatoid arthritis, methotrexate

7. Study Design

Primary Purpose
Treatment
Study Phase
Phase 2
Interventional Study Model
Parallel Assignment
Masking
ParticipantCare ProviderInvestigatorOutcomes Assessor
Allocation
Randomized
Enrollment
78 (Actual)

8. Arms, Groups, and Interventions

Arm Title
Canakinumab + Methotrexate
Arm Type
Experimental
Arm Description
Canakinumab, human anti-interleukin-1beta monoclonal antibody plus Methotrexate (MTX). Intravenous (IV) Infusion of 600mg canakinumab on Day 1, 15 continuing every 4 weeks up to week 26. MTX was given as variable dosing regimen of 7.5 mg-15 mg weekly.
Arm Title
Methotrexate + placebo
Arm Type
Active Comparator
Arm Description
Methotrexate (MTX) was given as variable dosing regimen of 7.5 mg-15 mg weekly. Intravenous (IV) Placebo Solution, given in the same mode of administration as the canakinumab solution.
Intervention Type
Drug
Intervention Name(s)
Canakinumab (investigational)
Other Intervention Name(s)
ACZ885
Intervention Description
Canakinumab was supplied in 6 mL colorless glass vials each containing nominally 150 mg canakinumab (with 20% overfill). The vials were kept at 2-8°C. At the investigator's site, solutions for infusion were prepared depending on the volume and dose administered.
Intervention Type
Drug
Intervention Name(s)
Placebo
Intervention Description
Matching placebo was supplied in form of a lyophilized cake (Powder for Solution for Infusion). At the investigator's site, solutions for infusion were prepared depending on the volume and dose administered.
Intervention Type
Drug
Intervention Name(s)
Methotrexate (MTX)
Intervention Description
Methotrexate (MTX) was supplied in tablet form, each of 2.5 mg strength.
Primary Outcome Measure Information:
Title
Response to Intravenous Canakinumab and Oral Methotrexate (MTX) Compared to MTX Alone as Determined by 50% Improvement in Symptoms According to the American College of Rheumatology Criteria (ACR50)
Description
A patient was considered as improved according to the ACR50 criteria if she/he had at least a 50 % improvement in both the tender and the swollen 28-joint count, and in at least 3 of the following 5 measures: Patient's pain assessment (Visual Analogue Scale (VAS) 100 mm) Patient's global assessment of disease activity (VAS 100 mm) Physician's global assessment of disease activity (VAS 100 mm) Patient self-assessed disability (Health Assessment Questionnaire (HAQ) score) Acute phase reactant (high sensitivity C-reactive Protein (hsCRP))
Time Frame
6, 14, and 26 weeks of treatment
Secondary Outcome Measure Information:
Title
Response to Intravenous (IV) Canakinumab and Oral Methotrexate (MTX) Therapy (ACR20, 70, 90) Compared to MTX Alone
Description
A patient was considered as improved according to the criteria of ACR 20 equaling at least 20%, ACR70 = 70%, and ACR90 = 90% improvement in the tender and the swollen 28-joint count, and in at least 3 of the following 5 measures: Patient's pain assessment (Visual Analogue Scale (VAS) 100 mm) Patient's global assessment of disease activity (VAS 100 mm) Physician's global assessment of disease activity (VAS 100 mm) Patient self-assessed disability (Health Assessment Questionnaire (HAQ) score) Acute phase reactant (high sensitivity C-reactive Protein (hsCRP))
Time Frame
At 6 weeks, 14 weeks, and 26 weeks
Title
Percentage of Participants Achieving a Good European League Against Rheumatism (EULAR) Response (Based on the Disease Activity Score (DAS28)) at 26 Weeks
Description
At each visit (including baseline) the DAS28 is derived as: DAS28 = 0.56*√ (tender28) + 0.28 * √ (swollen28) + 0.36 * loge(CRP+1) + 0.014*PGDA+ 0.96; where tender28 is the tender 28-joint count, swollen28 is the swollen 28-joint count, PGDA is the patient's global assessment of disease activity. Patients can be scored on a range of 0 to 10. When current DAS < 3.2, good response is defined as >1.2 improvement in DAS from baseline and non-response is improvement of ≤0.6. When current DAS >5.1, non-response is improvement of >0.6 but ≤1.2 . All others are moderate responses.
Time Frame
At 26 weeks
Title
The Number of Participants in Clinical Remission Based on Disease Activity Score (DAS)28 and Simplified Disease Activity Index (SDAI)
Description
At each visit (including baseline) the DAS28 and SDAI variables were derived using the following formulas: DAS28 = 0.56*√ (tender28) + 0.28 * √ (swollen28) + 0.36 * loge(CRP+1) + 0.014*PGDA+ 0.96; SDAI = tender28 + swollen28 + CRP + (PGDA / 10) + (EGDA / 10) where tender28 is the tender 28-joint count, swollen28 is the swollen 28-joint count, CRP is C-reactive protein, PGDA is the patient's global assessment of disease activity and EGDA is the physician's global assessment of disease activity. The Number of Participants in clinical remission is defined as the DAS28 ≤ 2.6 or SDAI ≤ 3.3.
Time Frame
At 6 weeks, 14 weeks and 24 weeks

10. Eligibility

Sex
All
Minimum Age & Unit of Time
18 Years
Maximum Age & Unit of Time
75 Years
Accepts Healthy Volunteers
No
Eligibility Criteria
Inclusion Criteria: Male and female patients of 18 to 75 years of age (inclusive) Recent definite diagnosis of rheumatoid arthritis (RA) (<3 years since diagnosis), classified by American Rheumatism Association 1987 revised criteria. Candidate for methotrexate (MTX) or biologic due to erosive arthritis, with no contraindications to such therapy, including: Negative tuberculin skin test reaction Normal chest X-ray (within the last year) prior to possibility of receiving MTX (r/o lung fibrosis). Active disease: at least 6 swollen and 6 painful tender joints of 28 joint count, Vital signs should be within the following ranges: 18-59 years of age: oral temperature between 35.0-37.5 °C systolic blood pressure, 90-140 mm Hg diastolic blood pressure, 50-90 mm Hg pulse rate, 40 - 90 beats per minute 60-75 years of age: oral temperature between 35.0-37.5 °C systolic blood pressure, 100-160 mm Hg diastolic blood pressure, 50-100 mm Hg pulse rate, 50 - 100 beats per minute Women of child-bearing potential willing to practice double-barrier contraception during the study for at least 3 months following last study drug administration. Postmenopausal women must have no regular menstrual bleeding for at least 1 year prior to inclusion. Surgically sterilized women at least 6 months prior to screening. Male patients must be using a double-barrier local contraception and refrain from fathering a child in the 3 months following last study drug administration. Weight: at least 45 kg; body mass index (BMI) within the range of 18 to 34. Oral corticosteroids are permitted as long as patients are on a stable dose (up to 10 mg) for at least 4 weeks before study start. Exclusion Criteria: Unable to have Magnetic Resonance Imaging (MRI) of wrist. Patients with magnetizable metal parts/devices on and in the body that could interfere with the MRI Patients with an unstable active medical condition that could impair evaluation of study results. Previous treatment with biological therapy or MTX. Limited kidney function (creatinine clearance under 60 ml/min) Previous treatment with other disease-modifying anti-rheumatic drugs such as sulfasalazine, hydroxychloroquine within 4 weeks of screening. Corticosteroids injections into joints within 4 weeks prior to screening. Participation in any clinical investigation within 4 weeks prior to study start or longer if required by local regulations, and for any other limitation of participation based on local regulations. Blood donation or loss of > 400 mL within 8 weeks before study start, or longer if required by local regulation. Significant illness within 2 weeks of study start. Past personal or family medical history of clinically significant ECG abnormalities or cardiac issues. History of: fainting, orthostatic hypotension, sinus arrhythmia asthma and chronic obstructive pulmonary disease, clinically significant drug allergy or urticaria, eczematous dermatitis, and/or known hypersensitivity to the study drug or drugs similar to the study drug. disease of the blood building system, serious or active infections, gastric ulcers. surgical or medical condition which might significantly alter the absorption, distribution, metabolism or excretion of drugs or which may jeopardize the patient in case of participation in the study. immunodeficiency diseases, including a positive Human Immunodeficiency Virus (HIV) (ELISA and Western blot) test result. positive Hepatitis B surface antigen (HBsAg) or Hepatitis C test result. drug or alcohol abuse within the 12 months prior to dosing or evidence of such abuse.
Overall Study Officials:
First Name & Middle Initial & Last Name & Degree
Novartis
Organizational Affiliation
Investigative site
Official's Role
Principal Investigator
Facility Information:
Facility Name
Rheumatology Associates of Northern Alabama (Dr. William Shergy)
City
Huntsville
State/Province
Alabama
ZIP/Postal Code
35801
Country
United States
Facility Name
Clinic for Rheumatic Diseases (Dr. Richard Jones, III)
City
Tuscaloosa
State/Province
Alabama
ZIP/Postal Code
35406
Country
United States
Facility Name
Arizona Arthritis and Rheumatology Research (Dr. Paul Caldron)
City
Paradise Valley
State/Province
Arizona
ZIP/Postal Code
85253
Country
United States
Facility Name
Jacksonville Center for Clinical Research (Dr. Steven Mathews)
City
Jacksonville
State/Province
Florida
ZIP/Postal Code
32216
Country
United States
Facility Name
Center for Arthritis and Rheumatic Diseases (Dr. Michael Weitz)
City
South Miami
State/Province
Florida
ZIP/Postal Code
33143
Country
United States
Facility Name
West Broward Rheumatology Associates, Incorporated (Dr. Elias Halpert)
City
Tamarac
State/Province
Florida
ZIP/Postal Code
33321
Country
United States
Facility Name
Rockford Orthopedic Associates (Dr. Richard Olson)
City
Rockford
State/Province
Illinois
ZIP/Postal Code
61107
Country
United States
Facility Name
Mercy Arthritis and Osteoporosis Center (Dr. Alan Braun)
City
Urbandale
State/Province
Iowa
ZIP/Postal Code
50322
Country
United States
Facility Name
Clayton Medical Research (Dr. Iri Don)
City
Richmond Heights
State/Province
Missouri
ZIP/Postal Code
63117
Country
United States
Facility Name
Westroads Medical Group (Dr. William Palmer)
City
Omaha
State/Province
Nebraska
ZIP/Postal Code
68114
Country
United States
Facility Name
Arthritis Center of Reno (Dr. Malin Prupas)
City
Reno
State/Province
Nevada
ZIP/Postal Code
89502
Country
United States
Facility Name
Oklahoma Center for Arthritis therapy and Research (Dr. James McKay)
City
Tulsa
State/Province
Oklahoma
ZIP/Postal Code
74104
Country
United States
Facility Name
MetaClin Research, Incorporated (Dr. Paul Pickrell)
City
Austin
State/Province
Texas
ZIP/Postal Code
78704
Country
United States
Facility Name
John M. Joseph, MD (Dr. John Joseph)
City
Carlton
State/Province
Texas
ZIP/Postal Code
75007
Country
United States
Facility Name
Southwest Rheumatology, P.A. (Dr. Atul Singhal)
City
Mesquite
State/Province
Texas
ZIP/Postal Code
75150
Country
United States
Facility Name
Arthritis Clinic of Northern Virginia (Dr. Philip Kempf)
City
Arlington
State/Province
Virginia
ZIP/Postal Code
22205
Country
United States
Facility Name
Arthritis Northwest Rheumatology, PLLC (Dr. Jeffrey Butler)
City
Spokane
State/Province
Washington
ZIP/Postal Code
99204
Country
United States
Facility Name
Novartis Investigative site
City
Brussels
Country
Belgium
Facility Name
Novartis investigative site
City
Nuernberg
Country
Germany
Facility Name
Novartis investigative site
City
Milan
Country
Italy
Facility Name
Novartis Investigative site
City
Arnhem
Country
Netherlands
Facility Name
Novartis investigative site
City
Barcelona
Country
Spain

12. IPD Sharing Statement

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Safety and Efficacy of Intravenous ACZ885 and Oral Methotrexate Therapy in Patients With Early Rheumatoid Arthritis

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